STATEN ISLAND UNIVERSITY HOSPITAL NORTHWELL

HEALTH

2016

CANCER PROGRAMEXECUTIVE SUMMARY

Completed October 2017

TABLE OF CONTENTS

Cancer Committee Membership……………………….. 3

Cancer Committee Chair Report………………………. 4-6

Surgical Oncology Report………………………. ……… 7

Pediatric Oncology Report………………………..……. 8

Cancer Registry Report………………………………… 9-10

Breast Health Navigator Report……………………….. 11

Gastrointestinal Nurse Navigator Report….…...……… 12

Lung Navigator Report…………………….…………… 13

Head and Neck Navigator Report………..……………. 14

Radiation Oncology Report…………………………….. 15-17

Radiology Report............................................................... 18

Rehabilitation Report…………………………………… 19-20

University Hospice Report…………..………………….. 21-23

Oncology Research Report……………………………... 24

Cancer Education and Prevention Report…………….. 25

Community Outreach Year End Summary…………… 26-33

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2016 CANCER COMMITTEE MEMBERSHIP

Lisa Carolan, RN, MHA, PI Program Manager

Nancy Caserta, RN,OCN, Breast Health Navigator

Raimonda Clark, RN, MA, M.ED, Associate Executive Director, Oncology Services

Cynara Coomer, MD, Cancer Liaison Physician

Claudine DeMarco, RN, MSN, Gastrointestinal Nurse Navigator

Frank Forte, MD, Director of Palliative Care Medicine

Kerry Gillespie, Director Complimentary Medicine

Nora Goldberg, Manager, Occupational Therapy

Laura Longo, RN, NP Director of Patient Care Services, Ambulatory Oncology

Michele Lotito, Health Information Management

Louise Madrigal, RN, BSN, OCN, CRC, Manager Clinical Research

Paula McAvoy, RN, MPS, OCN Adm Director University Hospice Oncology

Avery Miller, MS, CGC, Genetic Counselor

Lauren Moore, American Cancer Society

Lynne Opitz, MD Associate Chairman, Pathology

Antonio Picon, MD, Surgical Oncology

Deirdre Quirk, CTR, RHIA Cancer Registry Coordinator

Carolyn Raia, MD, Associate Chair, Department of Radiology

Carolyn Simone, LCSW, Manager of Community Education and Marketing

Terenig Terjanian, MD, Chairman, Cancer Committee

Denise Torsney, RN, Nurse Manager, 3B

Penny Troiano, MSW, LCSW, OCW-C, Oncology Social Worker

Sarah Vaiselbuh, MD, Pediatric Oncology

Philip Vigneri, DO, Chairman Radiation Oncology

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CANCER COMMITTEE CHAIR REPORT

Cancer management continues to be one of the major targets of healthcare realities. It is estimated that, this year, more than 1,688,780 million people will be diagnosed with cancer. In addition to the obligation of providing high quality cancer care to our community, the Cancer Center duty includes participating in cancer research to achieve the final goal of a cure for every kind of cancer. Progress has been made over the last thirty five years with an explosion of new and effective treatments achieving not only better survival but also a significant number of cures.

The Cancer Center was established in order to respond to the needs of the Staten Island community, and to avoid the burden of commuting to New York City for their care. For that reason, a comprehensive cancer care program including all of the aspects of the management of malignant disorders was created. All of the areas of cancer treatments are available at Staten Island University Hospital Northwell Health. Surgery, chemotherapy, radiation therapy, immunotherapy, nutritional and psycho-social services, patient education, cancer screening, physiotherapy, rehabilitation, palliative care program, hospice and community outreach. (Please see separate reports for the above mentioned programs).

All of these are provided through a coordinated multidisciplinary approach, using the most updated information available, consistent with national guideline recommendations in a dedicated environment that unites high quality care of an academic and well respected institution with the comfort, convenience, personal touch and dedication of private institutions or practices. For all of these reasons, the cancer program was accredited for another three years with commendation for a second time in a row in 2014, by the American College of Surgeons Commission on Cancer. This is an honor reserved to only about 75 institutions out of over a thousand. Our program is due for another survey in 2017. We hope to achieve the same high level of accreditation with commendation.

The multidisciplinary approach is at the heart of the cancer program. The intention is not only treatment, but to do so in a relaxing environment with all of the necessary ancillary and subspecialty services available, such as gynecologic and urologic oncologic consultations and follow up provided on site, although the Cancer Center has been principally the home of the Medical Oncology division since 1991. The center does not discriminate based on insurance coverage. All oncologic and hematologic patients are treated without distinction between “clinic” and “private” patients. The number of patient visits at the center is over 30,000 per year. At present, there are plans to move the location of the Cancer Center and expand it to accommodate the increasing number of patients since the present facility has reached near saturation levels.

As expected, there have been personnel changes at the attending physician’s level. Dr. Futuri moved to Washington and Dr. Alex Bershadskiy has joined our team.

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Features of the Cancer Center and program include the following:

Extensive chemotherapy treatment center offering the latest modalities with all of the recently available drugs in addition to the traditional treatments under the supervision of the attending physicians and Oncology certified nurses.

Fully equipped Radiation Oncology program (see separate report)

Palliative Care consulting services

Dedicated services for Pediatric Hematology and Oncology under the direction of Dr. Sarah Vaiselbuh

Four consultation and ten examination rooms with a sixteen chair outpatient chemotherapy unit

In patient oncology unit

On site laboratory services

Dedicated oncology pharmacy

Cancer information line

Nutritional services

Nurse Navigator programs

Genetic counseling

Social Services program to assist patients and families with financial assistance and counseling

Support groups and patient education programs

Up-to-date radiologic services (PET-CT, CAT scan, MRI, Nuclear Imaging, Digital Mammogram unit in addition to standard x rays)

Blood Bank unit with cytophoresis and plasmaphoresis capabilities

Cancer Registry Data

Hematology-Oncology Research program with the appropriate designated personnel

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Academic activities (lectures, conferences, journal clubs) in the conference center

Complementary Medicine services

ACGME-approved Hematology-Oncology fellowship program housing also a multihead microscope

Hospice program

Terenig Terjanian, MDChair, Cancer Committee

SURGICAL ONCOLOGY REPORT

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The number tissue committee variances increased in 2016 from 239 in 2015 to 278 in 2016.

Surgical attendance at Tumor Board in 2015 was more than 90% Cancer Committee set the required attendance at 80%. Every effort will be made to keep

the surgical attendance at a high level.

GOALS 2016

Tissue Committee:

Decrease the number of cancer related variances. Incorporate the pathology request form to the mandatory preoperative paperwork to be

filled out prior to every procedure. A committee was created in 2016 to define the enforcement of this requirement.

Enforce pathology slide review from an outside institution for all oncological cases. A committee was created in 2016 to define the enforcement of this requirement.

GOALS 2017

Surgical Oncology

Increase the number of surgical oncology cases by 5% in 2017. Increase and potentiate the role of our nurse navigator to help navigate our cancer

patients. Incorporate the Cancer Survivorship program into our practices. Create a stronger Gastroenterology/Surgery Multidisciplinary Conference, independent of

the Medical/Surgical Tumor Board. We are in the process of creating a Liver and Pancreas Center that will offer flawless care

to patients with neoplasm of the liver and pancreas.

Antonio I. Picon, MDDirector, Surgical Oncology

DEPARTMENT of PEDIATRICS – DIVISION OF HEMATO/ONCOLOGY

The Division of Pediatric Hemato/Oncology provides clinical services for children with cancers as well as benign blood disorders. Focus on outpatient chemotherapy (instead of hospitalization) is a unique feature of the Children’s Cancer Center at SIUH that aims at

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increasing the quality of life of both child and parents alike, since the children can return home in the evening to the familiarity of their own bedroom.

The Pediatric Hem/Onc division has developed policies and procedures fully integrated with Northwell standards of care. We trained mid-level providers who are the liaison between inpatient and outpatient nursing staff. They provide training programs for pediatric nurses so they gain confidence in the clinical management of oncology patients. As a core–rotation of the pediatric residency program, our faculty is daily involved in mentoring and guidance of rotating residents. Our faculty is highly productive in scholarly activity testified by 7 peer reviewed papers published in 2016. To further impact the academic productivity of Dept of Pediatrics and resident trainees at SIUH, Dr. Romanos plays a key role as co-chair of the research and scholarship committee. Dr Vaiselbuh is the principal investigator of her laboratory in exosomes in leukemia research at FIMR. Both attendings had multiple abstracts accepted for poster and/or oral presentations at national meetings.

We initiated Project S.M.I.L.E – a pain awareness and comfort program for children of all ages afflicted by disease. The residents are being trained in pain awareness and comfort kits are being distributed to help distract children during painful procedures such as needle sticks.

Our division is also home to the HistioCare program – a specialty program for children and adults affected by Histiocytic Disorders. We currently are a participating site of the International Registry for Rare Histiocytic Disorders (IRHDR).

Cancer Committee set the acquired attendance at 80%. The PHO attendance level has been persistently at 80% or above

Goals for 2017:

Expand the primary care referral base by use of EHR and Allscripts consultation notes to improve rapid communication with referring pediatricians.

Patient enrollment on LCH IV protocol (international protocol for treatment of Langerhans Cell Histiocytosis)

HistioCare Family Day (Dec 3rd 2017) in collaboration with the Histiocyte Society Develop research collaborations to enhance patient enrollment for PI initiated basic

science studies across Northwell Health Cancer services.Sarah R. Vaiselbuh, MD Director Pediatric Hemato-Oncology

CANCER REGISTRY REPORT

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The Cancer Registry is a database established to improve cancer care through the collection, maintenance, analysis and production of reports from oncology data. The entire database includes all cancer cases diagnosed and treated at Staten Island University Northwell Health since the registry’s reference date of 2002.

In 1989 the Cancer Registry converted to a computerized system of data entry and retrieval. Security measures for insuring confidentiality of data are strictly followed by the staff.

The Cancer Registry frequently provides oncology data for clinical studies, nurse navigators and the genetic counselor as well as for the purpose of both short-term and long-term planning for the institution. It also serves as a review of hospital utilization and quality of cancer care. To insure complete and accurate data abstracting and reporting, the registry staff and the Cancer Committee chairman perform an on-going quality control and review of completed cancer cases.

The Cancer Registry is also responsible for maintaining a 90% five year follow up rate on all eligible cancer patients, a requirement of the American College of Surgeons, Commission on Cancer. An 80% follow up rate for all eligible living patients is required as well. To maintain the current follow up rate for all eligible living patients is required. Follow up is maintained on each patient. Complete and accurate information is essential for compliance with standards of the Commission on Cancer and to provide high quality survival data.

In 2016 the five major cancer sites (analytic cases) treated here were:

Primary Site Total PercentageBreast 294 22.18%Bronchus & Lung 181 13.66%Hematopoietic & Reticuloendothelial System 102 7.7%Bladder 97 7.32%Colon 75 5.66%All Other Sites 576 43.48%Total 1,325 100%

In 2016, 1,537 new cancer cases were added to our current Cancer Registry database. Of the new 1,537 cases accessioned, 1,325 were analytic, (new diagnosed and/or treated at Staten Island University Hospital Northwell Health) and 212 were non analytic cases, (previously diagnosed and treated elsewhere but treated at SIUH for recurrent or persistent disease.) Distribution of cases by AJCC Stage includes unknown stage patients initially diagnosed at SIUH but not enough information for accurate staging and cancers that do not have AJCC staging such as bone marrow and brain.

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Stage 09%

Stage 128%

Stage 213%Stage 3

8%

Stage 416%

NA14%

UNK11%

2016 Analytic Cases Stage Distribution

Stage 0Stage 1Stage 2Stage 3Stage 4NAUNK

Stage Total Cases % of the Total CasesStage 0 125 9%Stage 1 377 29%Stage 2 172 13%Stage 3 106 8%Stage 4 209 16%NA 185 14%Unknown 151 11%Total Cases 1,325 100.00%

Deirdre Quirk, RHIA, CTRTumor Registry Coordinator

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Nurse Navigators

The Nurse Navigators at Staten Island University Hospital act as personal advocates for newly diagnosed breast cancer patients. Our nurse navigators provide their patients with counseling services so patients can effectively cope with the impact of breast cancer and subsequent lifestyle changes that occur as a result of their illness.

Nurse Navigators will assist their patients with following:

Organizing appointments and navigating through the healthcare system Provides necessary education and information on available options, informed decision

making process, and realistic goal setting in order to empower the patient and their family to actively participate in their plan of care

Provide support and educational materials Answer questions regarding patients upcoming treatment plan Collaborate with patients and their family Providing support to pre and post-surgical patients during hospitalization Facilitate the weekly multidisciplinary conferences

Nancy Caserta, RNNurse Navigator

Comprehensive Breast Center

Gastrointestinal Nurse Navigator

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The Gastrointestinal navigation program was instituted in the fall of 2013. The Gastrointestinal nurse navigator works closely with the Director of Surgical Oncology and navigates both GI and other Surgical Oncology cases at the request of the Director. These cases may include but are not limited to sarcoma and melanoma. The Nurse Navigator promotes timely quality care via personal guidance through the health care continuum. The primary goal of the Nurse Navigator is to decrease barriers to cancer care.

The Nurse Navigator will assist the patient with the following:

Orient patients to the cancer care system Coordination of appointments, procedures and testing with necessary subspecialties in a

timely manner Collaboration with the multidisciplinary team to facilitate the treatment plan Pre and post operative support Providing patient and family education related to diagnosis, treatment, chemotherapy

protocols, recovery, clinical trials, community resources as well as survivorship Development and facilitation of the Survivorship care plan Advocate on the patients behalf Additional activities: Participated in the hospital based bi annual Oncology Core Curriculum by presenting the

gastrointestinal and navigation content. Served as preceptor to the new navigator. Active member of the Oncology Nursing Society and the Academy of Nurse and

Patient Navigators

Claudine DeMarco RN, MSN Gastrointestinal Nurse Navigator

Ambulatory Oncology Navigation Davison

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Lung Health

Head & Neck

The Nurse Navigator provides multidisciplinary support ensuring timely coordination of comprehensive care. The goal of the Navigator is to coordinate standard of care practice.  The Nurse Navigator assists in coordination of multidisciplinary care from initial screening, to final diagnosis.  Included in this coordination of care is patient education and assistance with psychosocial issues arising from the barriers created by the cancer diagnosis. 

 

Increase the number of patients participating in the interdisciplinary navigation process by providing support to the multidisciplinary team of PMD, Radiologist, Otolaryngologists, Pulmonologists, Thoracic Surgeons, Radiation Oncologists and Oncologists.

Actively assist in the coordination of the self-pay Lung Cancer Screening currently being offered at Verrazano Radiology

Maintaining active membership for the “Lung Cancer Alliance” thus affording us the opportunity to be identified as a “Center of Excellence”

To continue supporting the efforts and coordination of the weekly Multidisciplinary CME Category I approved Lung Conference  and  monthly Head & Neck Conference

Maria A. Rapuzzi, RN, MPALung Health Nurse Navigator

Head/Neck Nurse Navigator

AMBULATORY ONCOLOGY NURSE NAVIGATORHEAD AND NECK SURVIVORSHIP

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The role of the Oncology Nurse Navigator uses a multidisciplinary approach to provide timely patient care from the beginning of a cancer diagnosis through survivorship. The Nurse Navigator is responsible for educating, coordinating, facilitating, and participating in all patient care. Nurse Navigators collaborate with all members of the health care team to make sure each patient is getting the best care and support they need throughout their cancer treatment. Upon completion of cancer treatment, Nurse Navigators create a survivorship treatment plan for each patient which includes a brief summary of the care they received, as well as long term side effects, follow up appointments, contact information, etc. A copy of this treatment plan is then sent to their primary medical doctor to further facilitate collaboration in medical care.

Collaborate and coordinate patient care in a timely manner from diagnosis through completion of cancer treatment.

Educate patients and their family members on all cancer treatments, side effects, and concerns before, during, and after treatment.

Continue to encourage patients to participate in cancer support groups.

Participate in monthly CME approved Head and Neck conference to facilitate a multidisciplinary plan of care for each patient.

Follow up and assess all patients post cancer treatment and continue to monitor for any/all long term side effects as well as any psychosocial issues. Refer patients to the proper support team when needed (nutrition, social workers, financial, etc.).

Provide survivorship treatment plans to all patients who have completed their cancer treatment.

Take part in yearly Head and Neck cancer screenings and continue to encourage and support all new patients in getting the treatment they need.

Patricia M. Altschuler BSN, RNHead and Neck Nurse Navigator/Survivorship

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DEPARTMENT OF RADIATION MEDICINE

CONSULTATIONS: Volume appears to be a zone, with a small gain in out-patients.

2010 2011 2012 2013 2014 2015 20160

100

200

300

400

500

600

700

In-ptOut-pt

PARTIAL BREAST IRRADIATION (PBI) - Given the concerns raised by recurrences in the TARGIT trial, a review was done of our cohort. Results found one recurrence in 98 cases (2013-2015). The drop in cases for 2016 reflects a period of medical leave.

Patients treated with IORT- 11 Patients treated with SAVI catheter- 29 Total patients treated with PBI- 40

PBI CASES PER YEAR

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2011 2012 2103 2014 2015 2016 Total

33 32 38 61 54 40 258

SBRT (FOCUSED TREATMENT) FOR STAGE I LUNG CANCER

SBRT for medically inoperable stage I lung cancer continued to gain acceptance. All patients were discussed at the multidisciplinary thoracic conference.

2011

2012 2013 2014 2015 2016 Total

6 9 11 12 12 14 64

2011 2012 2013 2014 2015 20160

2

4

6

8

10

12

14

16

failureLTFUexpcontrolled

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ARIA UPGRADE: The ARIA upgrade was completed with migration to the “cloud.” Other applications were also integrated into the service line with connections for viewing the “S” drive for policies and procedures and other department documents. Full integration into Smart Rounds is expected in 2017.

RESEARCH: Aimee Tarentino, RN was hired for research duties in the department. She will maintain follow-up data for the Xoft safety trial, RTOG 1005 and work to open new trials.

ACCELERATOR REPLACEMENT: The TrueBeam accelerator was brought on line in the fall. It brings new capabilities to the department including respiratory gating, cone beam CT for patient positioning, contour alignment with Vision RT, IGRT with KvKv, CBCT, IMRT delivery with volume modulated arc therapy (VMAT), Calypso (electromagnetic tracking).

Philip M. Vigneri, DO, FACROChairman, Radiation Oncology

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RADIOLOGY/BREAST IMAGING CENTER

INTRODUCTION: In 2016 there were several technologic advances and upgrades in the Breast Imaging Center as well as further staff development.

TECHNOLOGY: In February 2016 we installed our first Tomosynthesis unit. Tomosynthesis is the only supplemental screening tool that has been proven to increase sensitivity (more cancers detected) while improving specificity (less false positives).

ENVIRONMENT OF CARE: In 2016 our reception and waiting area were renovated to be in line with the décor of Comprehensive Breast Center

CLINICAL VOLUMES: The department performed 17,342 screening mammograms, 4,936 diagnostic mammograms, 4,862 breast ultrasounds, 1,013 interventional breast procedures. 166 breast cancer diagnoses were made, 83 of which were screen detected

2016 AUDIT AND BENCHMARKS:

RESULT BENCHMARK

CALL BACK RATE 10.8% 5-12%

SCREEN-DETECTEDCANCER RATE 4.8/1000 >2.5/1000

PPV1 4.11% 3-8%

PPV3 28.3% 20-40

GOALS FOR 2017:

Installation of our 2nd Tomosynthesis Mammography Unit Installation of Tomosynthesis capable biopsy equipment Work toward purchase of 3rd Tomosynthesis Unit Work toward offering more screening ultrasound appointment availability Integration of clinical systems/applications with Radiology service line at Northwell Health

Carolyn Raia, MD Associate Chair, Medical Director, Breast

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DEPARTMENT OF REHABILITATION MEDICINE

Speech Language Pathology

Acute Care Services/3B Oncology

Approximately 10-15 patients a month for dysphagia consultation Collaborates consistently with ENT for more advanced surgical and reconstructive

procedures on individuals with head and neck cancer. Ongoing assessment and treatment for diet modification and safe feeding strategies in 3B Improved awareness throughout the hospital for patients with head and neck related

cancers and their need for dysphagia and/or voice services. Instrumental assessments to include Modified Barium Swallow Studies (MBS) and

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) for a wider variety of oncological patients.

Working alongside Palliative Care team for advanced illness patients Ongoing collaboration among speech department and respiratory therapy, pulmonary,

and staff development regarding education of staff for voice prosthesis and tracheostomy care.

Participated in continuing education courses for techniques used with patients with head and neck cancer.

Outpatient services

Utilizing emailing among team members about pre-treatment patients to share SLP recommendations.

Optimizing the use of the nurse navigator for early identification for patients’ pre-treatment interventions (i.e. education, exercise program, diet modification). SLP follow-up as patient moves through individual care plan.

Oral cancer screenings for the community Participation in monthly head and neck cancer meetings Oral, Head & Neck Cancer support group held monthly Created social media forums for communication within the community Participated in continuing education courses for techniques used with patients with head

and neck cancer. Referral from community SLPs for Modified Barium Swallow Studies (MBS) Use of a shared tracking system for patients with head and neck cancer

Pediatric Rehab

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Total Referred for Services 6Total Patients seen in 2016 5 Patient referred but never seen due to re-hospitalization 1

Staff Education 1. Effects of Brain Cancer therapy on Quality of Life in Pediatric population.2. Pediatric Cancer Outcomes… Part 1 Leukemia3. Pediatric Cancer Outcomes…Part 2 Tumor types, Anatomy, Physiology, Medical

Treatment Strategies

Physical Therapy

Out Patient PT provided 296 visits for patients with Lower Extremity Lymphedema and 291 visits for patients on Hospice Program

Neuropsychology

Neuropsychology saw 3 patients for follow-up neuropsychological testing. All were pediatric patients

Occupational Therapy

Provided 171 visits for patients with UE lymphedema OT Specialist lectured at the breast cancer support group OT collaborated with the Comprehensive Breast Center and the boutique for compression

garments and pneumatic pumps Breast cancer patient education materials were updated to be more informative OT followed breast cancer patients preoperative to postoperative for preliminary

circumferential measurements and lymphedema education and precautions

Nora Goldberg Rehabilitation Medicine

University Hospice

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Mission StatementThe mission of University Hospice is to meet the needs of terminally ill patients, their families and loved ones, by providing comprehensive palliative care focusing on physical, social, emotional and spiritual support.

Scope of Service University Hospice provides palliative care for terminally ill patients and their families in Staten Island, Brooklyn & Queens. Care is provided by an interdisciplinary team 24 hours a day, 7 days a week. An interdisciplinary team approach to symptom management is utilized, focusing on comfort and quality of life. Inpatient care is available for patients requiring acute symptom management or respite care at SIUH. University Hospice has an extensive hospice nursing home program, the first in New York City. Extensive bereavement services are available including support groups, grief classes, children’s programs, memorial services and a library-media center. A volunteer program providing training three times a year with opportunities for volunteers in the home, nursing home, inpatient, office setting and Addeo Residence. Music Therapy Pet Therapy A Speakers Bureau is available for professionals and members of the community. University Hospice is Joint Commission accredited. An 8 bed Hospice Residential facility is available on the campus of Eger Rehabilitation Center.

Patient Care StatisticsTotal Referrals 1309Total Admissions 570Total Patient Days 27,654Average LOS 44Median LOS 13

Bereavement StatsEvents/Meetings Participants

Adult Bereavement Groups 48 326Children’s Bereavement Groups 2 2

Memorial ServicesSpring Memorial Service 1 73Tree of Remembrance December 2016 1 60

Hospice VolunteersActive Volunteers 35Total Volunteer Hrs. 2078There were three volunteer training programs in 2016

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Education & Outreach Attendance 463 Programs 35

FundraisingEfforts from the Annual Fundraiser, Holiday Ribbons and Memorial gifts were $64,810.

Performance ImprovementThe performance Improvement Plan of University Hospice is designed to objectively and systematically monitor, evaluate and improve patient care and administrative efficiency.

New for 2016: Quality Improvement activities utilize HCAHPS survey data for all of 2016. Compliance – PEPPER report-2014 data-evidence of high proportion of claims having

only one diagnosis. New process began October 2015 to capture all diagnosis documented on initial comprehensive assessment.

Collection of 7 NQF measures required by CMS- Achieved 100% compliance in required reporting for 2016.

Continuation of Advanced Illness initiatives with Palliative Care currently in ICU rolled out in 2016 to CCU. All patients assessed by Palliative Care team for potential Hospice services.

Efforts to improve access to volunteer services- small increase in utilization, efforts continued.

Emergency Preparedness- Improvements made to TAL and PAL capture and flood zone documentation. Participation in large scale DOH electronic preparedness drill. Completed active shooter training for staff in 2016.

Infection Control- 2016 focus on decreasing catheter related infections. All nursing staff completed CAUTI education. Continue to work on improving acceptance of influenza vaccination. Hospice staff at 92% immunized during the 2016/2017 flu season.

Plan for 2017: Improve perceptions in rating of hospice care, likelihood to recommend, and receiving

enough help with pain management as evidenced through Press Ganey Scores. Complete 2 Emergency Preparedness Drills or analysis of at least two actual events. Increase acceptance of influenza vaccination among contracted HHA. Continued Palliative Care and Hospice Collaboration as initiative rolls out to the SIUH

Emergency Department. Fall prevention initiative utilizing newly developed tool.

Initiatives/Challenges

The In/Pt Palliative Care program continues to expand but has significantly decreased In/Pt. Hospice days by rapidly consulting on patients and improving symptoms. Will focus in 2017 on

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In/Pt services at the South site, where palliative Care Services are provided only on a limited basis.E-prescribing requirements continue to be a staff resource concern as prescribing tasks take significantly longer.University Hospice continues to participate in a project to provide Palliative Care Education to Staten Island long term care facilities through the New York State Department of Health Delivery System Reform Incentive Payment Program (DSRIP.) Formal training regarding Palliative Care completed in April 2017. The initiative utilizes the 2014 IOM publication “Dying in America” and seeks to establish palliative care services in 10 Staten Island Long Term Care facilities utilizing the “National Consensus Project” guidelines. It should be noted that LTC hospice admissions have trended downward significantly and a direct correlation to the project effectiveness cannot be ruled out.

 

Paula McAvoy, RN, MPA, OCNAdministrative Director University Hospice

2016 ONCOLOGY RESEARCH REPORT

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The Department of Research within Medical Oncology continues to collaborate with the patient care team to enroll patients into oncology related clinical trials. We continue to offer our patient population access to clinical trials through cooperative group affiliations, industry sponsored studies and internal investigator initiated research.

Our Oncologists maintain active National Cancer Institute Investigator identification numbers and participate as members of our Oncology Clinical Investigations Committee (OCIC) which serves as a forum for discussing new studies, enrollment/screening statistics and other important research developments. We are proud to report that our Research Coordinator, Research Nurse and Manager of Clinical Research maintain certification with the Association of Clinical Research Professionals (ACRP).

A total of 1,325 analytical cases for 2016 was reported to the Department of Research. Enrolling 6% of our analytic cases equates to 80 enrollments. Enrolling 8% of our analytical cases equates to 106 enrollments.

Our total enrollment for 2016 was 116.

Louise Madrigal, RN, BSN, OCN, CRCManager, Clinical Research

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CANCER EDUCATION AND PREVENTION REPORT 2016

The Cancer Education department is committed to early cancer detection by providing free screenings and educational seminars to the community. Screenings are scheduled for breast, skin, head and neck, oral and colorectal cancer. Educational seminars and health fairs are scheduled to provide education and awareness to the community.

The Cancer Education department works with the American Cancer Society to provide community awareness and cancer prevention with educational lectures and activities such as: Making Strides Against Breast Cancer, Staten Island Quits, and Look Good…Feel Better. In addition, the Cancer Education department works with The Leukemia & Lymphoma Society and participates in their annual Light the Night Walk.

To help with the emotional needs of our patients, Cancer Services provides monthly support groups for breast cancer, a young adult breast cancer support group, oral, head and neck, a general cancer support group and a caregiver support group.

The Cancer Education department has a “Cancer Information Line” available to the public to call and obtain information on our services, brochures, and about upcoming events. The telephone number is 718-226-8888. In addition, we post a calendar of upcoming events on the SIUH website.

Throughout the year, we participated in local and national events to recognize survivors of cancer. The main event held yearly is the National Cancer Survivors Day, a day of recognition for all survivors of cancer and their families.

Carolyn Simone, LCSW

Manager of Community Education And Marketing

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2016 SIUH Screenings and Prevention Programs

The Cancer Services Program of Staten Island, which is a cooperative endeavour with NYS DOH to provide free breast , cervical and colorectal cancer screening to Staten Islands under insured and uninsured. Additionally this program provides all the diagnostic work up related to an abnormal finding and navigation into the Medicaid Cancer Treatment Program for eligible individuals diagnosed with breast, cervical, colon or prostate cancer. We provide community education on these cancers and also partake in activities specific to Cervical, Colon and Breast cancer awareness months. We work with the DOH on “Main Streets Go Blue” in March to increase colon cancer screenings and awareness. In cooperation with SIUH we distribute FIT kits during March to anyone applicable (average risk clients). We also have a special free colonoscopy program that we run in cooperation with the NYC DOH. We have been funded annually to provide 80 free colonoscopies. SIUH is not only the administrator of the CSP of SI but we are the main provider of services. We partner with various health care providers in the community to reach our target population. (RUMC, CHCR, 2 mobile vans, Regional Radiology, 2 private MD offices in addition to SIUH )

Procedure S.I.U.H All other Providers Total

Mammograms 546 362 908Clinical Breast Exam 226 376 602Gyn Exam 140 148 288Diagnostic Mammo 205 97 302Breast Ultrasound 185 101 286FNA w/ Guidance 1 8 9Core Bx 23 20 43Excisional Bx 13 2 15Mammo Needle Loc 9 1 10

Ultra guided core bx 19 15 34Stereotactic bx 14 5 19Surgical consult 34 21 55Colonoscopy 1 0 1FIT Kit 51 0 51Colposcopy w/bx 2 5 7Colpo w/bx and Ecc 3 8 11Final Diagnosis SIUH RUMCBreast 1 Ducal Ca In Situ 0 Ductal Ca In Situ

5 Invasive Breast Ca 1 Invasive Breast Ca3 ADH 0

Cervical 2 CIN 1 2 CIN I1 Atypia

Colorectal 0 0

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Follow up process

Clients found to have an abnormal finding (breast, cervical or colorectal) are contacted within 72 business hours to provide case management  services to address any barriers that could prevent or delay their(patients) seeking care.  They key components to our Case Management is assessment, planning, coordination and resource development. Clients are called by CM within 72 hours (preferably after the MD has spoken with the client) and the role of the CM is explained to the client. A barrier assessment is preformed and a client care plan formulated. Barriers identified are documented as well as the steps preformed to resolve. Clients are assisted with appointment s and reminder calls are placed to client 1-2 days prior to appointment. A barrier assessment is again provided at that time. If a client is found to have a pre-cancerous or cancer diagnosis they are referred immediately to the DQE (designated qualified entity) to evaluate and start application for the NYS Medicaid Cancer Treatment Program (MCTP) Clients not eligible are referred to sliding scale. (clients who are undocumented are not eligible for MCTP but are eligible for sliding scale)

MCTP is a Medicaid program for eligible persons who are found in need of treatment for breast, cervical, colon or prostate cancer. (and some pre-cancerous conditions needing treatment) . Once a client is enrolled they receive full Medicaid coverage for an initial enrollment period as determined by the type of cancer being treated. Recertification is yearly, if the client is still in need of treatment.

Breast Cancer Screenings

Breast Cancer is one of the highest cancers in the community. Evidence is found in the New York State Department of Health Cancer Registry and SIUH tumor registry frequency report. This screening is effective because we have a high incidence of breast cancer in Richmond County. National guidelines and Evidence based interventions followed are American Cancer Society, NCCN, and NCI. In addition, these screenings are effective because they are detecting breast cancer at an earlier stage, thus, decreasing the number of patients with late-stage disease. 772 breast cancer screenings were performed and 6 breast cancer diagnoses were made. 3 precancerous breast diagnoses were detected.

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Staten Island University Hospital Northwell HealthColorectal Cancer Awareness Seminar

March 31, 2016

This seminar increases awareness and education about colorectal cancer in the community. Content included facts about colon cancer, screening methods for prevention and early detection and preventive nutrition. There were 25 attendees. The marketing strategy was useful because the seminar was well attended. The attendees learned how to access and obtain a referral for a free colonoscopy through the Cancer Services program. In addition, colorectal informational tables were set up in the lobbies at the North and South site to further educate the community on colorectal cancer and provide information about FIT kits.

This seminar is useful to the community because colorectal cancer is one of the highest cancers in the community. Evidence is found in the New York State Department of Health Cancer Registry.

An evaluation tool was given to each attendee after the seminar. The presentation evaluation indicated that the attendees learned about the importance of screening for colorectal cancer and learned about preventive nutrition for colon cancer. The attendees also indicated that the presentation gave them the knowledge and support to make healthy decisions about their lifestyle.

March 31, 2016 Colon screenings

Colorectal Cancer is one of the highest cancers in the community. Evidence is found in the New York State Department of Health Cancer Registry and SIUH tumor board frequency report. This screening is effective because we have a high incidence in Richmond County and it can decrease late stage disease.

National guidelines and Evidence based interventions followed are American Cancer Society, National Comprehensive Cancer Network, and National Cancer Institute. 27 Fit kits were distributed with instruction for average risk clients. Out of 27 kits, 11 were retuned and all 11 were negative. The Cancer Services Program Director notifies each client of their results. If there is a negative finding, each client is notified of their results via mail. If there is a positive finding, each client is notified via phone, referral is given and patient is followed through to diagnosis.

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Staten Island University Hospital Northwell Health

Head & Neck Cancer Screening was on Tuesday, May 10, 2016 and here are the results:

7 participants were scheduled (2 cancelled) 5 Participants were screened.

Out of the 5 participants screened: 2 - were NORMAL 3 - were ABNORMAL

ZIP CODES NORMAL ABNORMAL

10305 1 -0-

10306 -0- 1

10312 2 1

TOTAL 3 2

Head and neck Follow-up, Effectiveness, and Access and Referral Process

The community outreach coordinator worked in collaboration with SIUH ENT department to coordinate and supervise a head and neck screening. The ENT, Dr. Hiltzik was the examiner for the May 10,2016 Head and Neck Screening and examined 5 participants. Out of the 5 participants, 3 had normal examinations and 2 were referred for further ENT evaluation. The ENT physician, Dr. Hiltzik, informed the patients of the results immediately following examination. If there is an abnormal finding, the dermatologist made recommendations for follow-up. These recommendations include but are not limited to, a referral to an ENT physician with or without biopsy. Patients were given a list of ENT specialists and instructed to schedule an appointment with an ENT of their choice.

The number of participants screened decreased from last year (2015). This was attributed to the marketing strategy to inform the public of the event. Northwell Health no longer permits flyers to be posted around hospital. Other marketing strategies included general distribution to all employees, monthly community outreach calendar with events is distributed to employees, advertised on SIUH website, advertisement in SI advance.

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Staten Island University Hospital Northwell Health Free Skin Cancer Screening was held on Wednesday, June 22, 2016 and here are the results:22 Participants were screened.

Out of the 22 participants screened 15- were NORMAL 7- were ABNORMAL

ZIP CODES NORMAL ABNORMAL

10301 -0- 1

10304 1 -0-

10305 2 -0-

10306 3 2

10308 3 -0-

10310 1 -0-

10312 1 1

10313 1 -0-

10314 2 2

11231 -0- 1

10028 1 -0-

TOTAL 15 7

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Skin Screening Follow up, Effectiveness and Referral Process

The community outreach coordinator worked in collaboration with the American Academy of Dermatology to coordinate and supervise a skin cancer screening. The dermatologist, Michael Kurzman, MD was the examiner for the June 22, 2016 skin cancer screening and performed a visual examination on 22 participants.

The dermatologist informed the patients of the results immediately following the examination. If there is an abnormal finding, the dermatologist made recommendations for follow-up and a referral was made. These recommendations include, but are not limited to, a referral to a dermatologist with or without biopsy. Patients were given a list of dermatologists and instructed to schedule an appointment with the dermatologist of their choice for follow-up. The screening was useful to the community based on the positive feedback from the participants. Marketing strategies were the same as last year and this continues to be effective since we have seen approximately the same number of participants for the past 3 years. Participants are able to access these free services because it is advertised in the community.

Great American Smoke Out

November 15, 2016

At Staten Island University Hospital, patches as well as education were provided to 21 employees and the community. The below numbers showed that the participants changed their habits/behaviors based on this program. This prevention program reduced the chance of these clients developing cancer.

Year TotalEnrolled

Contacted Lost StillSmoking

QuitSmoking

PercentageQuit

2016 21 18 3 13 5 27.7%

2016 Smoking Cessation ProgramYear Total

EnrolledContacted Lost Still

SmokingQuit

SmokingPercentage

Quit2016 102 71 31 50 21 29.6%

SIUH was the only smoking cessation program on Staten Island until October 2016. The smoking rate at the start of the program in 2004 on Staten Island was 27.4%. As of October 2015, the smoking rate on Staten Island decreased to 16.5%.

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FOLLOW-UP PROCESS

The program includes counseling, the use of the nicotine patch and a weekly support group. The follow-up for the program is by phone, 30 days after initial visit, as per the guidelines of the New York City Department of Health and Mental Hygiene. This program is effective because people changed their habits after attending this program. Community members were able to access this program because it is advertised in the community.

Smoking and/or the use of any tobacco products is not permitted anywhere in the hospital, or on the hospital grounds. SIUH is a Tobacco Free campus, the first in New York City to designate this policy, which is now a New York City law. SIUH is committed to providing a healthy environment for our patients, family, visitors, medical staff and employees. Tobacco use has been cited as the chief avoidable cause of illness and death in our society and accounts for more than 435,000 deaths each year in the United States. Smoking is a known cause of multiple cancers, heart disease, stroke, complications of pregnancy, chronic obstructive pulmonary disease (COPD), and many other diseases. In addition, recent research has documented the substantial health dangers of second hand smoke. Second hand smoke is harmful to people of any age, but particularly harmful to children and the elderly. It is for this reason that SIUH provides our ‘Tobacco Free’ campus.

The commitment to a Tobacco Free Campus and to improving the health of all Staten Island residents extends to providing a comprehensive Tobacco Cessation Program that is available to all residents. The program includes individual and group sessions, along with a weekly support group. Our counseling sessions include evidence based approaches to both the physical and psychological basis of tobacco addiction. Along with tobacco cessation strategies, education on the various types of cessation medications is also given. The Hospital will provide a starter kit of nicotine patches to individuals once they enroll in the tobacco cessation program. A tobacco cessation program is also provided for patients that currently smoke on an inpatient basis, offering counseling and medication recommendations. In 2016, the System policy changed and all tabling had to take place in the hospital cafeteria, which eliminated community participation, and reduced our overall enrollment.

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Staten Island University Hospital-Northwell HealthFree Oral Cancer Screening

November 29, 2016

6 participants were screened4 were normal

2 were abnormal

Oral Screening Follow-Up

The community outreach coordinator worked in collaboration with Staten Island University Hospital’s Dental Department to coordinate and supervise an Oral cancer screening. The dentist, Donald Ratcliffe, DDS was the examiner for the November 29, 2016 oral cancer screening and performed an oral examination on 6 participants.

The dentist informed the patients of the results on examination. If there is an abnormal finding, the dentist made recommendations for follow-up. These recommendations include, but are not limited to, a referral to a dentist with or without biopsy. Patients were given a list of dentists and instructed to make an appointment with a dentist of their choice.

Respectively Submitted,

Carolyn Simone, LCSW-R

Manager of Community Education & Marketing

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